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Environmental Health Department <br />_ Date(8):1. <br />2. <br />) <br />3. <br />4. <br />5. <br />6. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPeQ«7ol11 <br />r, <br />J. <br />i <br />68 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | <br />D10-02 PW70I11 <br />M/2024 <br /> <br />Phone: C* I f u Alternate: ( <br />List food to be sold or given to the public: <br />I am providing food that Is NOT prepared at home: Yes^J No <br />All food is prepared on-site or Is from approved commercial facilities: Yes f&No <br />Name of facility:—--------------Phone: (--------)---------------—— <br />I am providing a^oth with the following: (to protect my unpackaged food and food-preparation areas from files, <br />dust and the public) <br />areas from the public. <br /> Other (specify): <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />^Approved bottled water. <br />^3 On-site hose bib that Is connected to a potable water source. <br /> <br />Sa?&«. - - .»> ™ »•«”»«' <br />, “2 “ “n. .. U poi.nfl.lly I— <br />135*F.’ <br />Fl Camp stove [Z] Sterno & hotel trays <br />0 Double steamer O Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />WOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />AJ! food vendore (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />me festival coordinator three (3) weeks prior to this event. u <br />1. Name of Event: OflletsY. ^L___L <br />The following Is Information about my organlzatlon/buslness: <br />Name of organlzatlon/buslness: ^nee-2^ <br />Address: lB£l Ohrsg feriufceAt5